Mincer's handout- Chronic Pain. Notes Week 6 Flashcards
What is the Biopsychosocial approach for Chronic Pain?
biological + beliefs, emotions, activity limitation, social (culture, work, participation restrictions) which mediate adherence/behavior change as well as outcomes; need may be indicated with yellow flags
What do you educate Chronic Pain patients about? (6)
- Role of cognitive & emotional influence
- Difference between acute and chronic
- Importance of central pain mechanisms
- Development of disability- pt. lets the pain prevent them from doing things, but they need to learn to push past pain.
- Frame beliefs and expectations in positive manner- always put a + spin on things to have a + effect
- Optimize coping strategies- show/ teach pts. ways to cope with their chronic pain or to prevent chronic pain
Examination/treatment principles of Chronic Pain Patients
- Assess psychosocial, and environmental factors in addition to biologic
- Encourage active vs passive role in planning- even more important for chronic pain pts.
- Set conservative, frequent, specific behavioral and functional patient goals- baby steps, helps to show positive progress, helps encourage pt.
- Anticipate barriers to progress and teach how to respond- not a straight road to recovery, teach CP patients to expect them and what to do when this happens
- Monitor and reinforce planned tasks- pt. feels like you are really invested in their success. ask them about progress when they come to clinic
- Anticipate and develop plan for relapse
More about Anticipate and develop plan for relapse
- Recovery is a long and bumpy road
- Educate patient about potential for step backwards or relapse of sorts
- Give patient tools/plan on how to deal with those pitfalls
- Objective is to empower patient to deal with it instead of getting discouraged and quitting
Specific Treaments for Chronic Pain (7)
- Cognitive behavioral therapy: To dec. threat and fear avoidance thru patient education, graded activity & ex, confronting negative beliefs-+ reinforcement, reinforcing behaviors etc- helps to dec. perceived threat
- Interdisciplinary, maybe individual or group, uses quotas/goals, reframing affective/cognitive responses, coping/relaxation, incorporates skills into daily life with practice, self-evaluation, monitoring, social reinforcement
- Graded exercise & graded exposure (activities- least feared to most feared): behavioral and cognitive tactics to inc. tolerance and function (NOT to dec. pain)- activities vs. exercise
- Neuroscience Ed: to dec. sensitization and pain by inc.understanding which will dec. perceived threat
- Modalities: use not supported for chronic pain just acute problem is tat pts. think this is what will get them better- psychological impact.With acute pts. it may have an effect.
- Radiculopathy: use LBRLP algorithm to identify likely source
- Cardio: may dec. depression, trigger points, and inc. well being, function, self-efficacy and symptoms
Mincer’s Notes about pharmacology and CLBP (6)
- Tylenol: safe, low $, first line
- NSAIDs: no more effective and significant side effects, esp w/ inc. duration
- Cox 2 may have dec. side effects but no more effective
- Gabipentin: short term effects in radiculopathy
- Benzodiazepines/ms relax: short term relief but risk abuse/addiction
- Corticosteroids: not recommended, even in sciatica
What do we care about patient satisfaction?
Patient satisfaction = PT’s professionalism, competence, friendliness, caring, empathy, respect, and communication re: condition, prognosis, self mgt
Thoughts/Notes on PT vs. surgery on Mincer’s handout
- Surgery may have more benefits in the short time but does not have that great long term effects over therapy
- Downside, scarred tissue, etc
- 1st priority with fusion is to protect the repair could cause delayed or non-union if motion occurs in this segment. Always defer to protocol if one is available.
Mincer notes on Mvmt impairment: pain avoidance (4)
- Too stable
- their response to pain is that they do not move
- use graded exercise & avoidance, mobes, manual therapy.
- DON’T use Manip might be intimidating
Mincer’s Notes on Motor control impairment: pain provocation
- have stability issues
- pts. positioning themselves in a way that makes their backs work.
- lack control in middle of the range so they stay at end range for stability.
- Only us MT if they are adaptively shortened anteriorly.
Under motor control impairment: pain provocation- Why do patients tend to go into repetitive strain position?
Because it feels more stable
From Mincer’s chronic pain sheet: Adaptive or Protective Altered Motor Response to an underlying disorder
- In a smaller circle so it is not as common
- deficits driven by pathology (though can include cntral and sympathetic mediated pain)
- correction hasn’t helped b/c they’re adaptive responses
- May benefit from addition of PT
From Mincer’s chronic pain sheet: Altered Motor response and centrally mediated pain due to dominant psychosocial factors
- In a smaller circle so it is not as common
- no pathology
- need interdisciplinary management (CBT/psych) and graded exposure
From Mincer’s chronic pain sheet: Over arching category in the big circle
Maladaptive Motor Control Patterns that Drive Pain Disorder
- specific pathoanatomical diagnosis but also psych/central sensitivity that contribute to pain
Two sub categories of Maladaptive Motor Control Patterns that Drive Pain Disorder
- Movement Impairment: Pain Avoidance
- Movement Control Impairment: Pain Provacation
